IAS: 'Watershed' Moment for Fight Against HIV/AIDS

by Michael Smith Michael Smith North American Correspondent, MedPage Today
July 18, 2011

ROME -- The battle against HIV and AIDS is at a "scientific watershed" and the world must now find ways to translate research into victory over the virus, the president of the International AIDS Society said at the association's 2011 conference.

The meeting comes after two years of "significant biomedical discoveries," said Elly Katabira, MD, of Uganda's Makarere University and president of the society.

Those discoveries include the recent proof that triple-drug therapy can prevent transmission of HIV, as well as hints of a successful vaccine and a first report of a working microbicide that can be used by women to prevent infection, Katabira told reporters as the conference opened.

Details of those and other findings -- many to be presented here -- may one day be seen "as important as the antiretroviral breakthroughs of the 1990s," Katabira said -- breakthroughs that changed HIV infection from a death sentence to a chronic disease.

But Katabira and others cautioned that scientific "proof alone is not enough" to turn the tide of the pandemic, which has claimed some 30 million lives in the past three decades.

Instead, they said, the goal now should be to mobilize both the public and private sector to translate the science into concrete action. The main focus should be to ensure widespread access to the medications that not only save lives but -- the "proof" Katabira spoke of -- can prevent the virus from being transmitted.

Currently, about half of the 33.3 million people with HIV around the world are not getting treatment, according to the United Nations, and deploying anti-HIV drugs to prevent transmission would put increased pressure on the drug supply.

"We are at a game-changing moment in the story of HIV/AIDS," said Michel Sidibe, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), largely because of the recent science.

But, he told MedPage Today, changing the game will require convincing governments to start thinking about "the end of this epidemic," instead of stopgap measures. And, he added, it will require more research -- this time on ways to cut costs and improve delivery of drugs and services.

The chances of stopping the pandemic "just got tremendously better," argued Chris Beyrer, MD, of Johns Hopkins University in Baltimore. "But we have now an enormous operations research challenge agenda in rolling out this science and getting people access to it."

There is "tremendous optimism in the field," he told MedPage Today, "that we can prevent new infections and save a large number of lives."

That optimism was boosted last week, when Gilead Sciences, of Foster City, Calif., agreed to allow four of its anti-HIV drugs to be copied generically, probably lowering their prices in the developing world.

This meeting will be the first to get full details on a major study that showed that treating the infected member of a couple -- well before it is clinically indicated -- dramatically reduces the risk of transmitting the virus.

Researchers will also present the final analysis of the blinded part of a study of pre-exposure prophylaxis among high-risk men who have sex with men, a trial that showed a 44% reduction in the risk of acquiring the virus for men who took a daily dose of an antiretroviral drug.

And details of two more studies among heterosexuals are expected to reinforce the lesson that anti-retroviral drugs can prevent transmission, as well as prolong life for people with HIV infection.

The conference also includes:

Early data on some new antiretroviral drugs.

Studies that show that rates of virological failure while on triple drug therapy have been falling both in the developed world and -- perhaps more importantly -- in some parts of the developing world.

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